OP0053 LUMBAR MECHANICALS TRACTIONS IN RADICULAR PAIN OF DISCUS ORIGIN: A PROSPECTIVE CONTROLLED RANDOMIZED TRIAL OF SUPERIORITY ON 428 PATIENTS IN REIMS HOSPITAL UNIVERSITY RHEUMATOLOGY SERVICE
Authors: E. Bernhard, A. Hittinger, I. Charlot-Lambrecht, M. Geoffroy, L. Pauvele, B. Loïs, C. Clément, H. Delaplace, J. H. Salmon
Journal: Annals of the Rheumatic Diseases (2022)

Background Medical cares guidelines for lumbosciatics pains are well codified in several country: NSAIDs, analgesics and physical therapy associated, at physician’s discretion, to lumbar epidural infiltrations. Lumbar mechanical tractions have not a clear identified place in the lumbosciatic pain treatment. It is empirically realized in France’s several medical centers. However, no current literature studies have shown a significant efficacity of lumbar mechanicals tractions in this indication. Most of the time, studies presented a lack of power or methodological bias. (1,2) Objectives The aim of this study is to demonstrate the superiority of lumbar traction associated with standard treatment (epidural injections, analgesics, NSAID) compared to medical treatment alone in lombosciatics pains of discal origin. Methods We performed a monocentric interventional prospective superiority study from 2013 to 2021, randomized controlled in the rheumatology unit of Reims University Hospital. Patients included had to present a lumboradicular pain, with a concordant discal hernia on MRI or scanner, and to be naive of any lumbar surgery. We recorded demographical and clinical data at baseline and during the follow up. After their consent, patients were randomized between the traction group and the medical group. The medical group received the standard treatment (NSAIDs, analgesics) associated with at least 2 epidural infiltrations. The traction group received the standard treatment, infiltrations and at least 3 lumbar tractions. Treatment was considered as effective if there was a pain diminution at least 25 % between baseline and at 1 month. Patients were assessed on their pain at baseline, at 1 month and at 3 months of their treatment. Pain was assessed using a visual analog scale on lumbar and radicular localisation. Superiority analysis has been performed by using the Chi-2 test. Results Four Hundred twenty-eight patients were included: 207 patients in the lumbar traction group, 210 patients in the medical treatment alone group and 11 patients with missing data. The male/female sex ratio was 1.39:1. The patients suffered from 49.52% (205 patients) right and 50.48% (209 patients) left lumboradiculalgia, mostly L5 (41% or 172 patients) and S1 (50% or 207 patients). The pains evaluation at one month was recorded for 377 patients: 190 in traction group (50.3%) and 187 in medical group (49.7%). Two hundred twelve/377 (56.2%) patients had a pain reduction of at least 25 % at one month: 117/377 patients in tractions group (31%) and 95/377 in medical group (25%). Twenty/377 patients (5%) were operated on before the one-month recall. Therefore, patients treated with lumbar traction had a significant reduction in pain (p=0.036) compared to patients with medical treatment alone. Conclusion This study is one of the first randomized controlled studies highlighting the superiority of lumbar traction in combination with standard treatment compared to medical treatment alone. References [1]Chou R, Huffman LH. Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2 oct 2007;147(7):492-504. [2]Wegner I, Widyahening IS, van Tulder MW, Blomberg SE, de Vet HC, Brønfort G, et al. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 19 août 2013;2013(8):CD003010. Disclosure of Interests None declared.